Congress advances on health care reform: one step at a time

In adopting the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Congress made a series of small but significant steps toward improving access to health care benefits. The Act's centerpiece is its new requirements for group health plans and for the health insurance industry for assuring portability, access, and renewability of health insurance coverage. Of nearly equal importance is the pilot program established for testing the viability of medical savings accounts. Other health-related changes include adjustments in the rules governing duplication and coordinating of Medicare-related plans, recommendations with respect to privacy of health information of employees, an increase in the deduction for health insurance costs for self-employed individuals, and permission for unemployed persons to make withdrawals from IRAs and other qualified plans for certain medical services' costs. This article summarizes these and other key provisions of HIPAA.     

Urban women's informal savings and credit systems in Zambia

This article is based on findings from semi-structured interviews and discussions among "chilimba" groups in Zambia. Chilimba groups are primarily women's groups that engage in credit and savings programs. Group membership ranges from 4 to 20 members. The women agree on a fixed, regular cash contribution that is given in turn to each member in a specified order. Market groups tend to be larger and contributions of about a dollar are made daily. Smaller groups tend to make larger, but less frequent contributions. Default is rare, as the commitment is taken very seriously. New members are added at the end of the rotation. Loans can be used for domestic or business use. Chilimba groups are evidence that very poor people desire savings. Chilimba brings together people with similar financial needs and resources. Chilimba does not require formal, written procedures or formal institutional frameworks. Chilimba is not a remedy for reducing overall poverty. It is appropriate only for people with some regular source of income. It does not serve as a safety net in emergencies. Long-term loans are not possible. A limitation is its openness and lack of structure that permit potential abuse. It is a livelihood strategy for women, but benefits could be gained from including men. It is urged that groups consider whether the position of the poor is being enhanced or undermined. Different models need to be tested. Members themselves must decide on the type and phasing of activities.